Healthcare Provider Details

I. General information

NPI: 1942738075
Provider Name (Legal Business Name): JOSHUA TASMA PT,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26319 WINDY TRACE DR
PERRYSBURG OH
43551-9347
US

IV. Provider business mailing address

26319 WINDY TRACE DR
PERRYSBURG OH
43551
US

V. Phone/Fax

Practice location:
  • Phone: 419-309-0854
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT019759
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: